Social Justice Advocacy as a Fifth Force in Counseling Psychology

Introduction

Social advocacy has been described by some counseling theorists as a "fifth force" paradigm that should rival, if not replace, other major counseling psychology paradigms regarding behavior and mental illness (Ratts, 2009). This paper briefly discusses what social justice and advocacy are, the debate regarding their status as a paradigm in counseling psychology, and how social advocacy can enhance both the client's experience and life and the professional counselor's personal, professional, and ethical obligations to helping others.

Social Advocacy as a 'Fifth Force' in Counseling Psychology

Social justice is fairness or impartiality exercised in society, specifically as it is implemented by and within different levels of social classes. A truly socially just populace would be based on the principles of solidarity and equality, and would consider and maintain values, human rights, and the dignity of every person in that society (Bell, 1997). Social justice and advocacy theories have in recent years been presented as valid psychological paradigms for counseling psychology.

According to Ratts, D'Andrea, and Arredondo (2004), the profession of counseling is being influenced by a growing movement directing professional counselors to incorporate a social justice perspective into counseling theories, paradigms, and practices. A counseling perspective incorporating social justice would consider issues surrounding the imbalance of power and oppression, and would focus on activism and social advocacy as a method to address the inequitable conditions in society that hinder the personal development, academic attainment, and career objectives of marginalized groups (Ratts, 2009). Ratts (2009) also claims that social advocacy as a means to address issues of societal inequity is in keeping with the American Counseling Association's Code of Ethics (American Counseling Association [ACA], 2005). He points out that Section A.6.a. of the code states clearly: "when appropriate, counselors advocate at the individual, group, institutional, and societal levels to examine potential barriers and obstacles that inhibit access and/or the growth and development of clients" (ACA, 2005, p. 5).

The relationship of social justice and social advocacy to counseling should go beyond simple partisan political affiliations or beliefs, according to Ratts and associates. For example, Ratts et al. (2004) make the case that social justice counseling constitutes a "fifth force" in the field, following the paradigms of the psychodynamic, cognitive-behavioral, existential-humanistic, and multicultural counseling paradigms that have been the backbone of theory and intervention in counseling. Other theorists have followed suit (e.g., Fouad, Gerstein, & Toporek, 2006; Lee, 2007). In more recent calls for the infusion of social advocacy and justice as a counseling psychology paradigm, Ratts et al. (2009) claim that the intentions of the counseling field are not effectively drawing the connection between oppression in marginalized groups and issues surrounding mental health. The issue for social justice advocates is that they believe the prominent counseling paradigms, whose focus tends to be on the individual without taking environmental factors into account, are limiting in their explanation of mental health. This notion has led Ratts and others to request an expansion of the counselor's role to include the concept of social justice advocacy (Ratts, 2009).

Several other authors have followed this call, justifying it on the grounds that social justice counseling is a resurfacing paradigm consistent with broader explanations of human behavior and with the methods by which the practice of counseling is currently being shaped (e.g., Greenleaf & Williams, 2009; Lee, 2007). In essence, this is an ethical argument for adopting a political, social, or philosophical point of view as a psychological paradigm — and one that has been rediscovered many times before. The fundamental premise of this ethical position is that long-established counseling paradigms in the form of individual, family, or other psychotherapeutic interventions have at times been unable to assist clients in maximizing their wellness and personal development. These researchers therefore claim that newly discovered links between systemic oppression and mental health issues indicate that many clients' problems are environmentally based (Greenleaf & Williams, 2009). This claim overlooks the extensive body of work by theorists such as Freud, Watson, Skinner, Lewin, Rogers, Allport, and many other classical psychological theorists who long ago described environmentally based factors that shape human behavior.

Nonetheless, the ACA created a task force to present a framework addressing issues of oppression, in order to assist the counseling profession in conceptualizing how social justice and advocacy counseling appears in clinical practice (Lewis, Arnold, House, & Toporek, 2002). These Advocacy Competencies outlined a model for counselors to follow when engaging in social justice counseling at multiple levels, including work with the client or student and with the school or community. At the client/student level, this involves empowering individuals to advocate for themselves and on behalf of others when appropriate. Advocacy at the school and community level emphasizes community involvement and entails collaboration with community leaders or organizations to identify and reduce oppressive situations and structures. Advocating at the public level focuses on making the general public aware of macro-systemic issues as they relate to human dignity, as well as acting as agents of change to remove barriers that obstruct the development of clients and students (Lewis et al., 2002).

According to Ratts (2009), despite the ACA's ethical mandate for advocacy and the creation of the Advocacy Competencies, a large number of counselors still fail to recognize the role of societal oppression in generating and perpetuating clients' issues. The profession remains filled with practitioners who exclusively adhere to an intrapsychic viewpoint to explain and alleviate client difficulties. In other words, social justice theory, according to Ratts and others, supersedes any other psychological explanation of a client's difficulties (see also Greenleaf & Williams, 2009).

According to Dohrenwend (2000), support for a paradigm shift in counseling can be found in empirical research on oppression and its effects on wellness and development. The evidence indicates that oppression leads to stress, and stress has dramatic physical and mental health consequences (Dohrenwend, 2000). Chronic stress in the form of oppression can produce associated physiological changes to the immune system and the brain that may result in psychological distress (Carlson, 2011), substance abuse (Carlson, 2011), increased rates of suicide (Dohrenwend, 2000), and increased risk for biological diseases such as coronary and infectious diseases (Carlson, 2011).

Dohrenwend (2000) also examined rates of physical and psychological problems related to stress and determined that, given the adversity inherent in racial prejudice, there were higher rates of depression, anxiety, and other psychological problems among disadvantaged groups. Turner and Avison (2003) found that African Americans reported higher instances of chronic stress compared with Caucasians over their lifetimes. Zyromski (2007) reported that post-traumatic stress disorder (PTSD) occurs more frequently in Hispanic, African American, and Latino youth than in European American youth, due to the greater exposure to violence and oppression experienced by these minorities.

Discrimination — a form of oppression — may also have consequences related to depression. For example, Gee (2002) discovered an association between depressive symptoms in Asian Americans and perceived discrimination, as well as an association between discrimination and overall poor mental health. Other researchers have found that perceived discrimination is negatively associated with self-esteem and positively associated with depressive symptoms and stress. Numerous additional studies support these relationships (Ratts, 2009).

Ratts (2009) charges that traditional intrapsychic-oriented approaches to mental health care, along with culturally biased diagnostic criteria, work to propagate various forms of cultural oppression and social injustice within the counseling profession. He further charges that various DSM-IV-TR diagnoses (e.g., anxiety, depression) are social indicators of the distress experienced by disenfranchised populations that lack power. Counselors should therefore anticipate that oppressed and underprivileged groups will demonstrate greater and more frequent symptoms of psychopathology and stress. Ratts (2009) also points to a correlation between marginalized populations and the misdiagnosis — both over- and under-diagnosis — of psychopathology. Thus, the fifth force in counseling should be social justice advocacy counseling. Despite the acceptance of the medical model in conceptualizing mental health, the intrapsychic framework it involves should conflict with legitimate counselors' core values and beliefs, according to some (Greenleaf & Williams, 2009; Ratts, 2009).

Despite the call for social advocacy as a counseling paradigm, this call to arms has not been embraced by all. Smith, Reynolds, and Rovnak (2009), for example, traced the history of the social advocacy movement and offered several criticisms of the proposed paradigm. Social advocacy purports that mental illness is the result of a societal illness and that counselors have a responsibility to right this injustice. Smith et al. (2009) identify three major concerns.

Opposition to the 'Fifth Force' Concept

First, they suggest that the social advocacy movement in counseling lacks sufficient control over its doctrine and as a result attempts to promote certain agendas — political, personal, economic, and others — labeled as "social action." Indeed, many of the tenets and precepts of current social justice advocates are aligned with postmodernist philosophy, which has been associated with Marxist principles by many scholars (e.g., Johnson, 2009; Nicholson & Seidman, 1995). This is not to suggest that social advocacy is subversive, but rather to understand how social justice advocates may attempt to promote certain political agendas under the name of science. There is no denying that upbringing, environment, and experience shape who we are — this has always been a fundamental principle of human behavior — but social advocates may attempt to exploit this principle in service of particular agendas. The issues of social change are typically tackled by political scientists, social researchers, and sociologists, rather than counselors or counselor educators.

Second, Smith et al. (2009) point out that social advocacy as a paradigm makes bold claims — such as being clinically effective — when there is little or no empirical evidence for those claims. The research on the effectiveness of social advocacy as a counseling paradigm suffers from poorly designed studies with small effects. The notion that societal illness leads to mental illness places the counselor in the role of an agent of social change rather than a clinician treating clients or families with personal issues. Social advocacy theory and practice are expressed in professions such as political science, social work, and sociology. It is unclear how a counselor would contribute to these professions while maintaining a separate professional identity. While some new advocacy competencies may possess face validity, there is little empirical support for their efficacy in counseling — and this is a key issue.

Reconsidering the research cited earlier: Dohrenwend (2000) notes the association between oppression, stress, and poor physical and mental health. However, closer examination reveals significant problems with his conclusions. It is stress, not oppression specifically, that is most robustly linked to health problems — a well-established and extensive literature (e.g., Carlson, 2011). If oppression were the only cause of stress, or if stress were the only cause of mental health issues, then Dohrenwend's conclusions might be defensible. In fact, stress has many causes: societal oppression, a difficult or abusive partner, job demands, divorce, marriage, and countless other life circumstances. Prolonged stress is associated with increased risk of poor health (Carlson, 2011), but it is not causal in a deterministic sense, since not everyone who experiences the same stressors develops health problems. Likewise, not every member of a disenfranchised group develops mental health problems. The distinction between correlation, association, and causation — as well as the proper definition of a risk factor — is elementary: a risk factor increases the probability of developing an illness or disorder, but it does not cause it (Redelmeier, Koehler, Liberman, & Tversky, 1995). Most of the research cited by Ratts and others that attempts to present societal oppression as a direct cause of mental illness is flawed in this same manner. If these theorists wish to define stress — rather than social oppression specifically — as a culprit and propose the study of stress-related illness as a new paradigm, they are arriving rather late; that paradigm already exists and is called health psychology (Marks, Murray, Evans, & Estacio, 2011).

Third, Smith et al. (2009) make a strong case that when one investigates the history of paradigms in psychology and counseling, there is little support for the assertion that social advocacy constitutes the "fifth force" in psychological thought. Instead, these authors view this movement as a recurring wave in the social sciences and in counseling. They note several past instances (e.g., Dworkin & Dworkin, 1971; Goldman, 1971) in which advocacy was encouraged as a response to the social trends of those times. Social advocacy is, in this sense, a historical label for the birth of the counseling profession itself. Ratts (2009) counters that the paradigm is not rediscovered but rather redefined, as Kuhn (1970) outlined.

Other issues that Smith et al. (2009) raise include the disenfranchisement of counselors who do not identify with the social advocacy movement — a concern that appears implicitly in both Ratts (2009) and Greenleaf and Williams (2009). Moreover, Ratts' (2009) assertion that the DSM-IV-TR diagnostic scheme was created to foster social oppression has no basis in fact. The existence of both over- and under-diagnosis of disorders in disenfranchised groups relates to inherent issues in the diagnostic classification system and in the individuals making diagnoses — not to some overarching plan by any ethnic group to exploit others. This assertion so thoroughly undermines what true social advocacy should encompass that it damages the credibility of the broader argument.

Furthermore, the assertion by Ratts (2009) and others (e.g., Greenleaf & Williams, 2009) that the ACA should prioritize social justice and advocacy theories over long-established paradigms is itself elitist and discriminatory. There is no evidence that social advocacy and justice counseling theory is the only legitimate explanation of psychological distress — in fact, there is little evidence that it is a fully legitimate explanation on its own. Neither the ACA nor any theorist has the right to dictate what paradigm a counselor follows when treating a client, except perhaps where a paradigm has been empirically demonstrated to be ineffective or harmful.

What forms of advocacy, moreover, should the ACA mandate? Are all forms of advocacy appropriate for every counseling professional or group? Smith et al. (2009) report that certain counselors have described an inability to advocate in particular ways due to their own cultural backgrounds. Should not these individuals have the right to abstain from forms of advocacy that conflict with their values and beliefs — for instance, on issues such as same-sex marriage or abortion? The worst form of disenfranchisement is an attack on someone's personal or professional character. The drive to be tolerant and culturally competent can ironically become intolerance for opposing views, as Smith et al. (2009) observe:

"Rigid criticism of dogma creates the potential for the oppressed to become the oppressor, wherein the oppressed use the strategies of the oppressor, such as labeling, personalization, isolation, and rigid adherence to one particular stance against another, rather than engage in thoughtful counter dialogue." (p. 491).